Provider Demographics
NPI:1770751414
Name:FORSYTH LYMPHATIC & WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:FORSYTH LYMPHATIC & WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:EASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CLT, CNMT
Authorized Official - Phone:770-844-9873
Mailing Address - Street 1:1620 GREYSTONE PL
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-5133
Mailing Address - Country:US
Mailing Address - Phone:770-844-9873
Mailing Address - Fax:770-844-5929
Practice Address - Street 1:327 DAHLONEGA ST STE A902
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2492
Practice Address - Country:US
Practice Address - Phone:404-218-7004
Practice Address - Fax:770-844-5929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center